七氟醚静吸复合麻醉对腹腔镜宫颈癌根治术患者血流动力学、认知功能及血清NGF和BDNF水平的影响  

Effect of sevoflurane inhalation combined with anesthesia on cognitive function,serum levels of NGF and BDNF in patients undergoing laparoscopic radical resection of cervical cancer

作　　者：李洪军 余云明 陈韵雨 李霞[1] 邓清华 LI Hong-jun;YU Yun-ming;CHENG Yun-yu(Department of Anesthesiology,Three Gorges Central Hospital Affiliated to Chongqing University,Chongqing 404000,China)

机构地区：[1]重庆大学附属三峡中心医院麻醉科,重庆404000

出　　处：《临床和实验医学杂志》2020年第18期1980-1984,共5页Journal of Clinical and Experimental Medicine

基　　金：重庆市科技计划项目(编号:wzstc-2017015)。

摘　　要：目的观察七氟醚静吸复合麻醉对腹腔镜宫颈癌根治术患者血流动力学相关指标、认知功能指标及神经生长因子(NGF)和血清脑源性神经营养因子(BDNF)的影响。方法前瞻性选取2017年2月至2019年4月重庆三峡中心医院收治的108例宫颈癌患者,按照随机分配的原则将其分为两组:对照组和观察组,每组各54例。观察组患者采用七氟醚静吸复合麻醉,对照组患者采用丙泊酚麻醉。对比两组患者不同时间点[麻醉前10 min(T0)、麻醉后10 min(T1)、手术进行时(T2)、手术结束后(T3)]的心率、血压及血氧饱和度等血流动力学指标,以及麻醉前,手术完成后1 d、3 d、5 d后连线试验(TMT)完成时间和简易智力状态检查量表(MMSE)评分等认知功能相关指标在麻醉前后变化以及NGF、BDNF在血清中分泌水平变化差异以判断七氟醚静吸复合麻醉对各指标的影响。结果在T0时,与对照组比较,观察组患者的血流动力学指标差异无统计学意义(P>0.05);在T1、T2、T3时,观察组患者的血流动力学指标较麻醉前均明显上升,且观察组均明显低于对照组中各指标,差异具有统计学意义(P<0.05);麻醉前,对照组和观察组患者的TMT完成时间和MMSE评分比较,差异无统计学意义(P>0.05);麻醉后,两组患者在手术完成后1d、3 d MMSE评分均较麻醉前明显降低,而观察组手术结束后5 d较麻醉前无显著性差异,且观察组患者的TMT完成时间和MMSE评分均与对照组存在明显差异(P<0.05)。两组患者术后血清NGF、BDNF水平均较治疗前明显下降,但术后组间的差异无统计学意义(P>0.05)。结论通过七氟醚静吸复合方式进行麻醉可使宫颈癌患者血清中分泌的NGF、BDNF含量降低,手术完成3 d内其认知功能有一定的影响,但在5 d内可回至麻醉前状态,说明其影响具有可逆性,但仍需在麻醉后给对各种体征进行监测以避免麻醉所引发的并发症。Objective To observe the effect of sevoflurane inhalation anesthesia on hemodynamics,cognitive function,nerve growth factor(NGF)and serum brain-derived neurotrophic factor(BDNF)in patients with laparoscopic radical hysterectomy.Methods 108 patients with cervical cancer admitted to Chongqing Three Gorges Central Hospital from February 2017 to April 2019 prospectively were divided into two groups according to the principle of random allocation,namely the control group and the observation group,54 cases in each group.Sevoflurane combined with inhalation anesthesia was used as observation group,while Propofol anesthesia was used in control group.The hemodynamics of heart rate,blood pressure and oxygen saturation were compared between the two groups at different time points[5 minutes before anesthesia(T0),5 minutes after anesthesia(T1),during operation(T2),and after operation(T3)].Before and after anesthesia,the completion time of Trail Making Test(TMT)and Mini-mental State Examination(MMSE)score and other cognitive function related indicators before and after operation,as well as the changes of NGF and BDNF secretion levels in serum before and after operation,were compared to determine the effects of sevoflurane intravenous inhalation combined anesthesia on these indicators.Results At T0,there was no significant difference in hemodynamics between the observation group and the control group(P>0.05).At T1,T2 and T3,the hemodynamics of the observation group was significantly higher than that before anesthesia,and the observation group was significantly lower than that of the control group(P<0.05).There was little difference in TMT completion time and MMSE score between the two groups before and after anesthesia.After anesthesia,the MMSE score of the two groups on the 1 d and 3 d after operation was significantly lower than that before anesthesia,while there was no significant difference in the observation group on the 5th day after operation compared with that before anesthesia(P>0.05),and the TMT completion time and MM

关 键 词：腹腔镜宫颈癌根治术 七氟醚 静吸复合麻醉 血流动力学 认知功能 脑源性神经营养因子 神经生长因子 

分 类 号：R614[医药卫生—麻醉学]